Individual
LOGAN GONZAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
564 SOUTH ST, HONOLULU, HI 96813-5013
(808) 591-1173
Mailing address
94-524 PALAI ST, WAIPAHU, HI 96797-1269
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-125822
HI
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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